This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Monday, February 13, 2012

Weekly Australian Health IT Links – 13th February, 2012.

Here are a few I have come across the last week or so.

Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

The big news of the week was clearly the public hearing at the PCEHR Senate Enquiry. I covered this in detail last week and there are a few more articles here in this blog.

There is really little else going on as we wait for the Senate to report and wait for clarity as to what NEHTA and DoHA are really going to deliver. The next few weeks are likely to be very interesting indeed!

A PARLIAMENTARY inquiry has heard the government body responsible for the planned e-health record system has become a “toxic workplace” operating under a “cloak of secrecy”, which has shut privacy advocates and consumers out of consultations.

Giving evidence before the inquiry into the legislation enabling the personally controlled e-health record (PCEHR), Medical Software Industry Association treasurer Dr Vincent McCauley complained about a lack of transparency from the National E-Health Transition Authority (NEHTA) – which is not subject to the same Freedom of Information laws as other government organisations – and of difficulty obtaining reports of safety assessments conducted as part of the implementation of the PCEHR.

“Without removing the cloak of secrecy… that currently covers NEHTA’s activities I believe that is impossible [to improve accountability],” Dr McCauley said.

Dr McCauley’s evidence echoed that of Australian Privacy Foundation chair Dr Roger Clarke, who had earlier told senators his organisation had been “held off to one side” throughout the consultation process surrounding the PCEHR.

At least three months after it was scheduled to allocate the next round of funding for the Personally Controlled Electronic Health Record (PCEHR) project, the Department of Health and Ageing (DoHA) has confirmed a figure has been finalised.

“The final details of the work package have been completed,” the spokesperson said. “The funding figure will be published shortly."

The spokesperson said the change in federal health ministers, from Nicola Roxon to Tanya Plibersek in December, had not caused any delay in the $466.7 million initiative, with the exact figure to be published “shortly”.

With less than five months before launch, differences between interest groups in the planning of the Federal Government’s $466.7 million personally controlled electronic health record (PCEHR) will be aired today before a Senate Committee.

Submissions from medical associations, privacy groups, rural and remote services, and the medical software industry collectively raise questions over privacy, standards and the ability to service remote regions.

Disciplinary records for dozens of doctors, nurses, and other health practitioners don’t show up on the national register – a new tool meant to improve transparency and public safety.

The sound of a thud from a nearby room alerted a nurse at Caloundra Nursing Home in Queensland, that something was wrong. When she went to investigate, she found her supervisor standing above an elderly resident, who was lying on the floor.

The supervisor, a registered nurse named Christopher James Jones, yelled at the resident, and kicked him, according to a decision of Queensland's Nursing Tribunal, which was at that time responsible for oversight of nurses in that state. The nurse said she also heard Jones call the resident an "old fool."

The violence so shocked the nurse that she couldn't eat or sleep for days. Yet

Jones was not stripped of his duties at the home. In fact, less than a week later, on March 12, 2004, he kicked another frail, elderly resident in his left hip, after pushing the man to the ground with a stool. This time, three staff members witnessed the incident, according to the judgment.

Julie Robotham

February 11, 2012

THE computer system that runs emergency departments across NSW is chronically underfunded and produces inadequate patient records, according to an independent report commissioned after some hospitals last year lost so much confidence in the software they returned to manual record-keeping.

But despite continuing problems and excessive time spent on data entry, the system - known as FirstNet - is too entrenched to be scrapped and the government should instead invest in bringing it up to scratch, according to the report by consultants Deloitte, obtained by the Herald under freedom-of-information laws.

Doctors and nurses were not adequately consulted on how the software should be used, the report found, and the system could not provide an acceptable record of the care received.

Response to Critical Safety Issue for the PCEHR

“I contend that it is nigh on impossible with the current HL7 CDA design, to build sufficient checks into the e-health system to ensure these sorts of errors won’t occur with real data, or to detect mismatch errors between the two parts of the documents once they have been sent to other providers or lodged in PCEHR repositories.”

Eric’s key issue is that

“One major problem with HL7 CDA, as currently specified for the PCEHR, is that data can be supplied simultaneously in two distinct, yet disconnected forms – one which is “human-readable”, narrative text displayable to a patient or clinician in a browser panel; the other comprising highly structured and coded clinical “entries” destined for later computer processing.”

It’s odd to hear the central design tenant of CDA described as a “major problem with CDA”. I think this betrays a fundamental misunderstanding of what CDA is, and why it exists. These misunderstandings were echoed in a number of the comments. CDA is built around the notion of a the twin forms – a human presentation, and a computer processible version. Given this, it’s an obvious issue about how the two relate to each other, and I spend at least an hour discussing this every time I do a CDA tutorial.

Note: This link is for those who want to see the other side of a complex discussion where it is. Close reading of the whole thread will make it clear just how hard and contested some of the details are! I leave it to others much smarter than myself to sort it out!

Dr. Avrim Fishkind, a psychiatrist in Houston, rarely sees any of his patients in person, and that's the way they like it.

Fishkind is part of a fast growing movement in the mental healthcare field where therapists counsel patients via inexpensive, Web-based video conferencing technology.

"We've had just over 60,000 patient encounters. To my knowledge, only six have refused to be seen via teleconferencing," he said. "When it comes to mental health issues and the difficult things you need to talk about in a crisis, a lot of patients feel it's less threatening and easier to be open and communicate via telemedicine."

Fishkind said telepsychiatry is limited only by insurance reimbursements. As more insurance companies start to reimburse for telepsychiatry treatments at the same rate as they do for in-person visits, the emerging medical field will grow exponentially.

AS the Gillard government's plans for electronic health records were raked across the coals this week at a Senate inquiry, one arm of the Health Department is going it alone.

While organ donor information is to be included in the proposed $500 million Personally Controlled E-Health Records program, the Australian Organ and Tissue Donation and Transplantation Authority is poised to put out to tender specifications for its own national electronic donor record.

The goal: streamlining the sensitive and complex process of moving organs from donation to transplant. The present system is based on a paper form almost 20 pages long.

"We called for an expression of interest late last year and various companies responded," says AOTA general manager Elizabeth Flynn, adding that the firms built "dummy systems" that were trialled in confidence.

The Royal Australian College of General Practitioners (RACGP) has weighed into the debate surround the PCEHR, stating GPs must have confidence in the system if it is to succeed.

The statements were made in the RACGP’s recently-released comments on the legislation surrounding the PCEHR.

According to Dr John Bennett, chair of the RACGP National Standing Committee, the RACGP takes issue with several aspects of the PCEHR Bill.

These issues include the need for clear governance, clarity regarding the administrative burden on GPs, and issues associated with the professional and financial risks associated with breaching provisions of the legislation.
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The National e-Health Technology Authority (NEHTA) has told a Senate inquiry hearing that while building the new e-health records system was very complex it was still on track.

The authority was responding to a savage attack by the software industry and privacy advocates, who claimed the Federal health department had failed to provide the support needed to maintain the e-health records in the longer-term.

The Medical Software Industry Association and the Australian Privacy Foundation called for a pared-back scheme to be introduced on July 1 this year, with a second-stage release to follow in mid-2013 when more functions have been finalised.

But chief executive of NEHTA, Peter Flemming, told the Senate committee in Canberra: "NEHTA began this journey back in 2005 and on July 1 the personally-controlled electronic health record (PCEHR) will be available for consumers to register."

Six-week delay to live implementation.

The Federal Government's decision to halt work at preliminary sites testing components of the personally controlled electronic health record have cost the project a further six weeks delay, according to one of the sites involved.

Metro North Brisbane Medicare Local chief executive Abbe Anderson told a Senate inquiry inspecting legislation for the e-health project that her implementation site now planned to sign up the first consumers to test live shared health summaries in mid-March, rather than January 30 as previously planned.

The delay comes after ten of 12 implementation sites were told by the National E-Health Transition Authority (NEHTA) on January 19 to halt work on "primary care desktop software development" due to "technical incompatibilities across versions" of the specifications provided to the sites in November last year.

Doubts about Australia’s $A467 million Personally Controlled Electronic Health Record (PCEHR) project have emerged during submissions to a Senate inquiry underway this week in Canberra.

Under the proposed scheme, due to begin operation on July 1 2012, all Australians will have the option of registering for a PCEHR, designed to ensure medical professionals have access to comprehensive patient data.

The Australian Medical Association (AMA) does not believe that requiring patients to “opt-in” to the PHECR will deliver a sufficient uptake to make the system successful.

The head of the Australian Medical Association (AMA), Dr Steve Hambleton, has told the senate hearing into the PCEHR legislation that the deadline for the electronic record’s introduction is problematic.

The PCEHR is set to become available to every Australian wanting one on July 1, 2012.

Dr Hambleton said the AMA supports the development of ehealth records, but he also stated a working system is years from completion.

He told the hearing there are problems with expectation levels associated with the introduction of the record, and with the ability of doctors to deliver meaningful connectivity using the record by the July 1 deadline.

The Queensland Government has released a laundry list of National Broadband Network (NBN) opportunities it will seize if it is returned to power in the upcoming state election, which includes partnering with the CSIRO, Energex, local governments and NBN Co to make sure that those in the state get the most from the incoming fibre network.

The 12-page plan said that the state government will look to align infrastructure deployment with local disaster rebuilding efforts, among other initiatives.

The January 2010 floods that tore through Grantham in the Lockyer Valley saw countless properties destroyed, and left a repair bill of several billion dollars. As the rebuilding effort continues, the Queensland Government is looking to speed up the NBN roll-out in construction areas.

"The Queensland Government is working with NBN Co to identify opportunities to align NBN infrastructure plans as part of the disaster reconstruction effort.

The path computing has taken wasn't inevitable. Even today's machines rely on a seminal insight from the scientist who cracked Nazi Germany's codes.

By Simson L. Garfinkel

When Alan Turing was born 100 years ago, on June 23, 1912, a computer was not a thing—it was a person. Computers, most of whom were women, were hired to perform repetitive calculations for hours on end. The practice dated back to the 1750s, when Alexis-Claude ­Clairaut recruited two fellow astronomers to help him plot the orbit of Halley's comet. ­Clairaut's approach was to slice time into segments and, using Newton's laws, calculate the changes to the comet's position as it passed Jupiter and Saturn. The team worked for five months, repeating the process again and again as they slowly plotted the course of the celestial bodies.

Today we call this process dynamic simulation; Clairaut's contemporaries called it an abomination. They desired a science of fundamental laws and beautiful equations, not tables and tables of numbers. Still, his team made a close prediction of the perihelion of Halley's comet. Over the following century and a half, computational methods came to dominate astronomy and engineering.